Question 1

What is ICD-10 code H25.091?

Accepted Answer

H25.091 is the ICD-10-CM diagnosis code for other age-related incipient cataract, right eye. An early-stage clouding of the lens in the right eye that develops with age and does not fit other specific cataract categories. H25.091 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of lens (h25-h28).

H25.091 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code represents early or incipient cataracts that are not yet fully developed.

Question 2

Is H25.091 an HCC code?

Accepted Answer

No. H25.091 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H25.091 billable?

Accepted Answer

Yes. H25.091 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H25.091 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H25.091?

Accepted Answer

H25.091 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H25.091 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H25.091?

Accepted Answer

This code represents early or incipient cataracts that are not yet fully developed Ensure documentation specifies right eye and that the cataract is in an early stage

H25.091

Is H25.091 an HCC code?

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Open H25.091 in the Interactive Encoder